OXFORD DEANERY ACADEMIC CLINICAL FELLOWSHIP IN
ANAESTHETICS (ST3)
Academic Clinical Fellowship (ACF) posts have been awarded by the NIHR to
University/NHS Trust/Deanery partnerships nationally through competition. These
posts form part of the NIHR Integrated Training Pathway, further details of which can
be found on the NIHR TCC website http://www.nihrtcc.nhs.uk. All posts will have an
NTN-A.
About Oxford Deanery
The Oxford Deanery covers the counties of Oxfordshire, Berkshire and
Buckinghamshire. The School of Anaesthetics training programme is centred on the
Oxford Radcliffe NHS Trust, and incorporates rotations with Trusts in Milton Keynes
in North Buckinghamshire, High Wycombe and Aylesbury in Buckinghamshire to the
east, and Reading and Slough in Berkshire, to the south and east. We also have one
ST5 training post in The Great Western Hospital, Swindon.
The Oxford Deanery is part of the South Central Strategic Health Authority which
serves a large population and covers the regions mentioned above as well as the
Wessex Deanery areas of Hampshire and the Isle of Wight. The Oxford Deanery is
responsible for the training of some 1500 trainees, of whom over 130 are anaesthetic
trainees.
The Anaesthetic Specialty Registrar Training Programme (ST3-7)
The Anaesthetic ST training programme is a 5 year programme, starting at ST3. The
ACF post will occupy the first 3 years of the training programme. All new trainees are
trained according to the 2010 curriculum of the Royal College of Anaesthetists
(http://www.rcoa.ac.uk/index.asp?PageID=1479 ). During this time, the trainee's
work is monitored for satisfactory progress and subject to annual reviews in the form
of ARCPs. Progression on the programme is dependent upon these reviews. With
the recent introduction of the College ePortfolio, we expect trainees to increasingly
avail of this method of assessment and record-keeping and it will be mandatory for
all new trainees from August 2012.
The posts on this rotation have been approved for Specialist Training by the Royal
College of Anaesthetists and the GMC. The posts attract National Training Numbers
and provide training towards a Certificate of Completion of Training (CCT).
The Postgraduate Dean has confirmed that these posts have the necessary
educational and staffing approvals.
Further information on the Oxford Deanery Anaesthetics Specialty Training
Programme can be found on the School website:
http://sites.google.com/site/oxfordanaesthesiaschool/home
Key Contacts:
Head of School: Dr Oliver Dyar (Oliver.Dyar@nda.ox.ac.uk )
Programme Director: Dr Vivian Addy (Vaddy@btinternet.com )
Programme Manager: Mrs Mairi Hills (Mairi.Hills@Oxforddeanery.nhs.uk )
Academic Programme Director: Professor Irene Tracey, Head, NDA & Director,
FMRIB Centre. (irene.tracey@nda.ox.ac.uk )
The programme is based in several different Trusts throughout the Oxford Deanery
so trainees may find themselves employed by any of the following Trusts and placed
in any of the following hospitals:
Trust
Oxford Radcliffe Hospitals
NHS Trust
Hospitals and Locations
John Radcliffe Hospital, Headington, Oxford
http://www.oxfordradcliffe.nhs.uk/home.aspx
Churchill Hospital, Headington, Oxford
http://www.oxfordradcliffe.nhs.uk/home.aspx
Nuffield Orthopaedic Centre
Nuffield Orthopaedic Centre, Headington, Oxford
NHS Trust*
http://www.noc.nhs.uk/
Heatherwood and Wexham
Park Hospitals NHS
Foundation Trust
Royal Berkshire NHS
Foundation Trust
Buckinghamshire
Healthcare NHS Trust
Wexham Park Hospital, Slough
http://www.heatherwoodandwexham.nhs.uk/location/wexhampark-hospital-slough
Royal Berkshire Hospital, Reading
http://www.royalberkshire.nhs.uk/
Stoke Mandeville, Aylesbury
http://www.buckshealthcare.nhs.uk/
Wycombe Hospital, High Wycombe
http://www.buckshealthcare.nhs.uk/
Great Western Hospitals
NHS Foundation Trust
Great Western Hospital, Swindon
http://www.swindon-marlborough.nhs.uk/
Milton Keynes Hospital NHS
Foundation Trust
Milton Keynes General Hospital
http://www.mkgeneral.nhs.uk/
* As from 1 November 2011 the Nuffield Orthopaedic Centre NHS Trust will become part
of the Oxford Radcliffe Trust
Rotation Information
Expected rotation arrangements for this programme are:
 ST3 year is spent at the hospitals Oxford Radcliffe NHS Trust Hospital:
training and experience in the specialist areas (tertiary referral) some of which
are not available in the DGHs, e.g. neuro, cardiac anaesthesia; Intensive care
(first 3 months of required 6 months) paediatrics.
 ST4 and ST5 are spent in a DGH. In ST4 the trainee is expected to complete
the competencies of Intermediate level training which have not been gained in
Oxford. This and success at the Final FRCA exam lead to the receipt of the
Intermediate Level Training Certificate. In ST5, higher level training begins.
This is a particularly intense period, as the majority of the components of the
General Duties Essential Unit are undertaken.
(http://www.rcoa.ac.uk/docs/CCTinAnaestheticsAnnexDHigherLevelTrainingAug2010Ed2V1.3.doc)
 ST6 and ST7 are spent at the hospitals of the Oxford Radcliffe NHS Trust,
where the final components of higher and advanced training are undertaken,
leading to the completion of training and the recommendation for CCT.
However, this can change depending on the needs of the trainees and the training
programme.
The School provides training and experience in all the required areas of the new
(2010) curriculum, and at the appropriate level (basic/intermediate/higher/advanced)
using this system.
Description of research component of programme:
The ACF will have 9 months of protected research time during the course of the
programme. Whether the research time is given as day or block release will be
determined based upon the research programme selected. The research time will
be spent at the University of Oxford and within the newly formed Nuffield Department
of Clinical Neurosciences, within which is the Nuffield Division of Anaesthetics
(NDA).
The ACF will benefit from new state-of-the-art laboratory facilities at the West Wing,
part of the new hospital on the John Radcliffe Hospital site, as well as the Oxford
Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), one of the
world’s leading human neuroimaging centres. As such, there is an outstanding
environment and opportunity for training anaesthetists to participate in world class,
internationally competitive research. There is a proven track record of mentoring
young researchers by scientists and academic clinicians. From the time of
appointment, each ACF will be attached to the NDA academic mentor for this
scheme (Professor Tracey, who is Head of NDA and Director of FMRIB Centre)
alongside their research supervisor. Together, regular meetings with the trainee and
his/her clinical supervisor will occur to oversee that appropriate training (research
and clinical) is being provided throughout the course of the programme. With the
bringing together of anaesthetics, clinical neurology, FMRIB and ophthalmology into
one larger department (the Nuffield Department of Clinical Neurosciences), the
opportunity for novel research collaborations and sharing of high-end equipment has
rapidly expanded for anaesthetics due to this increased critical mass. This is a very
exciting time to join the NDA where the research opportunities fall within four broad
categories:
1) PAIN:
(a) Pain neuroimaging group, led by Professor Tracey, investigating human central
nervous system mechanisms of nociceptive processing in acute and chronic pain
and their relief by pharmacological agents using state-of-the-art neuroimaging
techniques, including a recently installed 7 Tesla whole body MR system.
(b) Systematic reviews and analysis of analgesic efficacy (led by Professor Andrew
Moore)
(c) Oxford Persistent Postoperative Pain Study (OxPPOPS) (led by Dr Jane Quinlan
and Dr Katie Warnaby).
(2) RESPIRATION:
(a) Systems respiration (led by Dr Kyle Pattinson). Predominantly uses neuroimaging
to investigate mechanisms of respiratory control in health and disease.
(b) Cellular respiration (led by Dr Jaideep Pandit). Investigates the basic cellular and
molecular aspects of respiratory control.
(c) Modelling respiration (led by Dr Andrew Farmery). Using combination of cellular
and modelling approaches to tackle the issue of tissue oxygenation and perfusion.
(3) INTENSIVE CARE:
(a) Improving patient safety in the intensive care environment with national trial
based studies (led by Dr Duncan Young).
(b) Neuro-intensive neuroimaging studies of patients post subarachnoid
haemorrhage (led by Drs Matt Rowland, Kyle Pattinson, Jon Westbrook and
Professor Jezzard)
(4) MECHANISMS OF ANAESTHESIA:
Using neuroimaging to understand at a systems level the neural underpinnings of
anaesthesia induced states of unconsciousness in humans (led by Drs Róisín Ní
Mhuircheartaigh, Richard Rogers and Professor Tracey)
(5) SIMULATION and MEDICAL EDUCATION:
In addition, we have developed a new simulation centre, the OxSTAR Centre, that
provides training via simulation and in collaboration with the Education Department
(Professor Ingrid Lund) research studies to determine the impact that simulation
training has on medical training (led by Dr Helen Higham).
A key goal of the Academic Clinical Fellowship (ACF) programme is to provide the
applicant with appropriate research experience and training, to enable the successful
application for an externally funded Clinical Training Fellowship, usually of 3-year
duration and leading to a higher research degree or equivalent further postgraduate
experience. If at the end of the ACF post, if funding applications are not successful
and clinical competencies are met, a place will be available on the clinical training
programme ) to complete CCT as part of Oxford School.
Trust Information
Oxford Hospitals
Trusts:
Oxford Radcliffe Hospitals NHS Trust
Nuffield Orthopaedic Centre NHS Trust
Nuffield Department of Anaesthetics
The Nuffield Department of Anaesthetics comprises closely associated University
and NHS departments, and is one of the largest anaesthetic departments in the
country. The Nuffield Department provides anaesthetic and critical care services to
all of the Oxford Hospitals.
The John Radcliffe Hospital is the principal teaching hospital with a main complex of
10 operating theatres and adjacent recovery and critical care areas, including the
Adult and Paediatric Intensive Care Units and the Cardiothoracic Critical Care Unit.
The Emergency Medicine Department and Trauma Service are also based here. The
Women's Centre at the John Radcliffe has 2 Gynaecology theatres and 3 Obstetric
theatres, and there are over 6500 deliveries per year. Neurosciences, ENT, plastic
and craniofacial surgery and the Oxford Eye Hospital moved to the new purpose built
West Wing in 2008. The West Wing has 14 operating theatres and the
Neurosciences Intensive Care Unit. The new purpose built Children's Hospital is also
on the John Radcliffe site, and the Oxford Heart Centre opened in 2009.
The Churchill Hospital has 10 operating theatres, the Churchill Intensive Care Unit,
the Renal and Chest Units, and the new Cancer Centre which opened in 2009.
Current specialties include gynae-oncology, urology, transplant, breast cancer,
upper/lower GI and bariatric surgery, and radiotherapy. The Pain Relief Unit is also
based at the Churchill Hospital.
The Nuffield Orthopaedic Centre has 6 theatres for elective orthopaedic surgery, the
Bone Infection Unit and Bone Tumour Service.
Royal Berkshire Hospital
Trust: Royal Berkshire NHS Foundation Trust
The Royal Berkshire Hospital is a busy district general hospital (32,000 surgical
cases per year), which provides all services other than cardio-thoracic,
neurosurgical, plastic and major neonatal surgery.
All the surgical specialties at Reading carry out major cases within their field in
addition to the routine work e.g. major head and neck work in ENT. The General
surgeons perform major vascular and gastrointestinal work including
oesophagectomies and laparoscopic assisted colectomies. The orthopaedic
consultants do major back surgery, tertiary shoulder surgery, and revision
arthroplasty as well as general orthopaedics. The urology department regularly
perform laparoscopic nephrectomies, prostatectomies and cystectomies using
robotic assistance as well as open procedures. There is ample opportunity to
increase exposure to paediatric practice. The hospital has 2 spiral CT and 2 MRI
scanners with regular opportunities to anaesthetise in these environments.
The anaesthetic equipment is of a very high standard and fully complies with minimal
monitoring standards; it is undergoing a staged upgrade. We have a tradition of
allowing anaesthetists free choice in the techniques they can use and have
equipment to support the use of Total Intravenous Anaesthesia and Low Flow
Desflurane techniques. There is a core group of consultants enthusiastic to teach
upper limb regional blocks. A dedicated emergency theatre is available 24 hours a
day and every effort is made to ensure that all emergency work and non-elective
work is completed by 22.00 hrs in keeping with CEPOD recommendations.
The purpose built ICU has 11 beds and cares for 700 patients annually (8%
paediatric). The unit is supported by a highly motivated nursing team, and has been
involved in multi-centre research trials. Since 1999 it has had a computerised Clinical
Information System. Continuous cardiac output monitoring, haemofiltration,
percutaneous tracheostomy and intracranial pressure monitoring are all standard
procedures. Transoesophageal and transthoracic echocardiography is being
developed. It is one of the few ICUs in the UK to run a successful follow-up
programme. A 24 hour Outreach service has been developed over the last few
years. A separate consultant on call rota covers the unit and trainees do a threemonth ICU attachment. There is a senior joint CCT post in Intensive Care that
rotates with John Radcliffe.
There is a Pain management unit in purpose built area. There are three consultants
and two full time nurses with an interest in pain management. The unit offers a wide
range of invasive, drug based and pain management therapies. We have introduced
an Advanced Training Module in Pain for senior trainees. All other our trainees have
the opportunity to have a dedicated attachment in pain to cover specific topics, gain
competencies and to give them an opportunity to see what it involves as a
subspecialty.
Each trainee is allocated an Educational Supervisor, signs an Educational Contract
and develops a personal development plan. There is weekly viva practice; weekly
FRCA based teaching and Post-Fellowship Management/Career Development Study
Days four times a year as well as opportunities to deliver teaching/viva practice. A
new Simulation Centre opened in November 2009 featuring SimMan 3G, SimNewB
and SimBaby. This will be a multidisciplinary facility with access for anaesthetic
trainees.
We are lucky that we have been able to develop a team of high calibre clinical
anaesthetists with a variety of different special interests as well as styles. Some of
the consultants have a high profile either politically, within management or specialist
anaesthetic associations. We have a group of keen consultants who are particularly
involved in teaching, training, help with examinations and career progression of
trainees.
Over the last few years we have introduced consultant appraisal by trainees and are
pleased to say that the feedback has been very positive in the main. We have
achieved a very impressive success rate at the primary and final examinations. Year
on year our trainee satisfaction recorded by PHEEM feedback shows that trainees
look upon the Royal Berkshire as a good place to train.
Milton Keynes Hospital
Trust: Milton Keynes General Hospital NHS Trust
Anaesthetic Dept Website: www.mkdeptanaesthetics.com
Milton Keynes General Phase I opened in April 1984 and contained 361 beds and 4
operating theatres. Phase II, commissioned in 1991, comprised 188 beds – only a
portion of these Phase II beds are currently open but the final bed complement will
be 529. There are two theatre blocks totaling 8 working theatres, together with a
treatment and diagnostic unit, which increases the total number of theatres to 12.
The hospital has a 9 bed Critical Care Unit offering invasive and non-invasive
ventilation, intracranial pressure monitoring, haemofiltration and invasive cardiac
monitoring.
Specialities covered include: general surgery, trauma and orthopaedics, urology,
ENT, ophthalmic, vascular, emergency medicine, obstetrics and gynaecology and
paediatric and day surgery. The obstetric unit covers approximately 3000 deliveries
per year, there is a 24 hour epidural service and twice-weekly elective caesarean
section lists. The hospital also has a chronic pain relief unit, CT scanning unit,
community dental clinic, pathology and x-ray, the latter containing a fixed MRI
scanner which is one of the most advanced in the UK.
Buckinghamshire Hospitals
Trust: Buckinghamshire Hospitals NHS Trust
Stoke Mandeville Hospital
We are a District General Hospital with a difference! We do all the emergency
surgery for Buckinghamshire Hospitals except for Vascular and some Obstetric and
Gynae emergencies. We also house the National Spinal Injuries Centre and do
elective and emergency Spinal Surgery. There is a sub-regional Burns/Plastics Unit
on site and a large (2 dedicated operating theatres) Ophthalmic Unit. Our work is
complementary to Wycombe hospital which does the major part of elective general
and orthopaedic surgery.
Wycombe General Hospital
Wycombe Hospital is a busy town centre general hospital. It offers a wide range of
acute hospital services including 24 hour Accident and Emergency (non-surgical),
Critical Care, Elective General Surgery, General Medicine, Elective Trauma and
Orthopaedic Surgery and Women's and Children's Services. The hospital provides
a specialist centre for Urology. Vascular Surgery and Heart Investigative Services
are also based on this site.
Wycombe Hospital has undergone a £40m PFI improvement scheme and is now
home to the Buckinghamshire NHS Trust Specialist Surgical Centre. The Centre is
a dedicated facility for all routine general surgical, urological and orthopaedic
operations that may require a stay of one or more nights.
Wexham Park and Heatherwood Hospital
Trust: Heatherwood and Wexham Park Hospitals NHS Trust
Wexham Park Hospital, Slough, the principal hospital in the Trust, is a busy District
General Hospital. It provides services for acute medicine and surgery, emergency
medicine, ENT, gynaecology, haematology, obstetrics, orthopaedics and trauma,
plastic surgery, psychiatry and urology. There is a new theatre block at Wexham
Park with 9 state of the art theatres including 3 with Laminar Flow. This theatre block
also houses seminar rooms with extensive teaching facilities for presentations. There
is a new 12 bedded ITU/HDU close to the theatre suite which has full time dedicated
consultant cover. There is also an active invasive cardiology unit undertaking
angiography, permanent pacemakers and implantable defibrillators. There will soon
be an angioplasty service. The Obstetric Unit has 4000 deliveries per year.
Heatherwood Hospital, Ascot provides services for elective orthopaedics, urology,
general and day-care surgery and a low risk Obstetric Unit. There is also a Chronic
Pain Clinic and services are provided for acute medicine and psychiatry.
Heatherwood Hospital has a suite of 5 operating theatres with two dedicated to
orthopaedics and one to day-case surgery. The obstetric theatre is within the
Delivery Suite. All emergency anaesthetics at Heatherwood Hospital are provided by
career grade anaesthetists.
King Edward VII Hospital, Windsor is purely an Ophthalmological Centre as far as
the provision of anaesthetic services is concerned.
In total there are 94 operating lists including 10 emergency lists, 8 ophthalmic lists, 2
community dental lists, 4 ECT sessions, 1 paediatric oncology session, 1 paediatric
MRI session and 7 chronic pain relief sessions.
There is an active teaching programme and excellent facilities at the Post Graduate
Medical Education Centre.
The Great Western Hospital
Trust: Swindon and Marlborough NHS Trust
The Great Western Hospital is a large District General Hospital, the Department
provides Anaesthesia for Ophthalmic, ENT, Oral, Orthopaedic, Emergency Medicine,
Gynaecology, General, Urological and Vascular Surgery. There are 15 operating
theatres all equipped with modern anaesthetic machines and full monitoring
equipment.
The Obstetric Unit is housed one floor above main theatres. There is a Delivery Suite
with integral operating theatre. A Special Care Baby Unit is nearby. A 24-hour
epidural service is provided with 11 dedicated anaesthetic sessions to the Delivery
Suite per week. A regular antenatal anaesthetic assessment clinic is held fortnightly.
The Pain Clinic offers an outpatient service for chronic pain sufferers. Four sessions
per week are devoted to this. A Pain Management Programme which runs in
conjunction with colleagues from Clinical Physiology, Occupational Health and
Physiotherapy, takes place twice a year. There is an Acute Pain Team, led by Dr
Baigel with four nursing sisters.
An Anaesthetic Pre-assesment Clinic led by Dr Clare van Hamel is run daily to see
patients with potential anaesthetic problems.
Teaching

All Trusts have regular teaching programmes
Duties of Post

Clinical, teaching, audit/research
Main Conditions of Service
Appointments to this programme are subject to the Terms and Conditions of Service
(TCS) for Hospital Medical and Dental Staff (England and Wales). In addition
appointments are subject to:



Applicants having the right to work and be a doctor or dentist in training in the
UK
Registration with the General Medical Council
Pre-employment checks carried out by the Trust HR department, including
CRB checks and occupational health clearance.
The employing Trust’s offer of employment is expected to be on the following
nationally agreed terms:
Hours – The working hours for junior doctors in training are now 48-hours (or 52hours if working on a derogated rota) averaged over 26 weeks (six months). Doctors
in training also have an individual right to opt-out if they choose to do so, but they
cannot opt-out of rest break or leave requirements. However, the contracts for
doctors in training make clear that overall hours must not exceed 56 hours in a
week (New Deal Contract requirements) across all their employments and any
locum work they do.
http://www.nhsemployers.org/PlanningYourWorkforce/MedicalWorkforce/EWTD/P
ages/EWTD.aspx
Pay – you should be paid monthly at the rates set out in the national terms and
conditions of service for hospital medical and dental staff and doctors in public health
medicine and the community health service (England and Wales), “the TCS”, as
amended from time to time. The payscales are reviewed annually. Current rates of
pay may be viewed at
http://www.nhsemployers.org/PayAndContracts/Pay%20circulars/Pages/PayCircular
sMedicalandDental.aspx
Pay supplement –depending upon the working pattern and hours of duty you are
contracted to undertake by the employer you should be paid a monthly additional
pay supplement at the rates set out in paragraph 22 of the TCS. The current
payscales may be viewed at
http://www.nhsemployers.org/PayAndContracts/Pay%20circulars/Pages/PayCircular
sMedicalandDental.aspx . The pay supplement is not reckonable for NHS pension
purposes. The pay supplement will be determined by the employer and should be
made clear in their offer of employment and subject to monitoring.
Pension – you will be entitled to join or continue as a member of the NHS Pension
Scheme, subject to its terms and rules, which may be amended from time to time. If
you leave the programme for out of programme experience you may have a gap in
your pension contributions. More information can be found at
http://www.nhsbsa.nhs.uk/pensions
Annual Leave – your entitlement to annual leave will be five or six weeks per annum
depending on your previous service/incremental point, as set out in paragraphs 205206 of the TCS. The TCS may be viewed at
http://www.nhsemployers.org/PAYANDCONTRACTS/JUNIORDOCTORSDENTISTS
GPREG/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.aspx
Sick pay – entitlements are outlined in paragraph 225 of the TCS.
Notice –you will be required to give your employer and entitled to receive from them
notice in accordance with paragraphs 195-196 of the TCS.
Study Leave –the employer is expected to offer study leave in accordance with
paragraphs 250-254 of the TCS. Local policy and procedure will be explained at
induction.
Travel Expenses – the employer is expected to offer travel expenses in accordance
with paragraphs 277-308 of the TCS for journeys incurred in performing your duties.
Local policy and procedure should be explained at induction.
Subsistence expenses – the employer is expected to offer subsistence expenses in
accordance with paragraph 311 of the TCS. Local policy and procedure should be
explained at induction.
Relocation expenses – the employer will have a local policy for relocation expenses
based on paragraphs 314 – 315 of the TCS and national guidance at
http://www.nhsemployers.org/PAYANDCONTRACTS/JUNIORDOCTORSDENTISTS
GPREG/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.aspx.
You are advised to check eligibility and confirm any entitlement with the employer
before incurring any expenditure.
Pre-employment checks – all NHS employers are required to undertake preemployment checks. The employer will confirm their local arrangements, which are
expected to be in line with national guidance at
http://www.nhsemployers.org/RecruitmentAndRetention/Employmentchecks/Pages/Employment-checks.aspx
Professional registration – it will be a requirement of employment that you have
professional registration with the GMC for the duration of your employment. Though
the post is covered by NHS Indemnity, you are strongly advised to register with the
MPS for professional indemnity.
Health and Safety – all employers have a duty to protect their workers from harm.
You should be advised by the employer of local policies and procedures intended to
protect your health and safety and expected to comply with these.
Disciplinary and grievance procedures – the employer will have local policies and
procedures for dealing with any disciplinary concerns or grievances you may have.
They should advise you how to access these, not later than eight weeks after
commencement of employment.
Educational Supervisor – the employer or a nominated deputy (usually the Director
of Medical Education) will confirm your supervisor on commencement.
General information on the Deanery’s management of Specialty Training
programmes, including issues such as taking time out of programme and dealing
with concerns or complaints, is available at www.oxforddeanery.nhs.uk and in the
national ‘Gold guide’ to Specialty Training at http://www.mmc.nhs.uk
October 2011